Thursday, July 29, 2010

Editorial: Mental services need a major overhaul

The Province, July 29, 2010.

How does our health system do when it comes to treating people with serious psychiatric illnesses? Very poorly, according to Vancouver forensic social worker Tracey Young, who says B.C.'s mental-health services are chronically underfunded and understaffed.

Young said time and time she's heard from family members who were heartbroken as they watched the deteriorating mental health of their loved ones - and powerless as they found hospital and other doors slammed in their face.

Young cited the tragic case of Kimberly Ruth Noyes, of Grand Forks, who was charged with second-degree murder in the 2009 slaying of 12-year-old neighbour John David Fulton.

In court last Friday, she was found not criminally responsible, due to a mental disorder.

Noyes' sisters had testified in court that for years they'd tried to have Kimberly committed.

And the Fulton family said Tuesday it was clear she was a danger to children: "Yet she was released back into the community over and over again."

Health services spokesman Karl Hardt said services in the region were well-resourced, but officials were very limited in what they could force a person to take advantage of.

"This was an extremely rare case," he noted.

Our view, though, is this is simply an extreme example of what is all too common in B.C., namely a lack of proper treatment for those with serious mental illnesses and a lack of support for their distraught families.

Monday, July 26, 2010

Having met more than my fair share of crack users and addicts in my frontline work, I've come to learn this is just the most brutal drug to get off of and stay off. It just messes people up and keeps them coming back for more and more and more.

I've known a couple who have been long poly-drug users, main drug of choice is crack and one thing that has helped them and the entire community immensely has been that they've been able to maintain housing for years. They've taught me a lot. They volunteer in the community, they're both dealing with the health impacts of a life of high-risk behaviour (HIV, Hep). They've got housing, so they can live a more stable life, albeit one still addicted. They care about each other, about their family and their community.

I wish we could figure out a way to create the kind of low-barrier (ie. hard to house) housing that is the first step for containing the harm done by people who are cycling through crack and poly-drug addiction. Help people access health care, mental health/psychiatric care. The solutions are available. They won't work for every single person, people quite literally fry their brains for good after a while of doing dope for so long. It's smart and good public policy for us to take care of people. It decreases the damage done too.

One story that comes to mind to look at the harm that can result from the devastation of crack addiction is the story of the Brotherson family:

Inside the trial of a former Highlands councillor and his two sons, found not guilty of murder

Louise Dickson,February 1, 2010, Times Colonist.

Crown prosecutor Carmen Rogers painted Brotherston Sr. as a man desperate to protect his sons, a father dragged against his will into their crack world, forced to clean up their messes, pay off their drug debts, take them to hospital, pay for rehab.

VANCOUVER – Crack use is the No. 1 street drug problem in many communities in B.C. but the issue does not get as much attention as it deserves.

And as crack use rises in Canada, so does the urgent need for targeted prevention and treatment programs—especially in smaller communities. That’s the conclusion of a new study led by Simon Fraser University health sciences researcher Benedikt Fischer.

In a paper to be published in Drugs: Education, Prevention and Policy next month, Fischer’s team documents a recent investigation of the social, health and drug-use characteristics of 148 primary crack users in three mid-sized B.C. communities: Nanaimo, Campbell River and Prince George.

Past studies have focused on larger urban settings and confirm that crack users are more likely than other drug users to face significant health problems such as HIV, Hepatitis C virus (HCV), sexually transmitted diseases, and mental illness. They also feature a distinct social profile characterized by extreme poverty, homelessness and illegal income generation.

Fischer’s study focused on crack users in non-urban communities to determine their unique characteristics and how best to target and deliver prevention and treatment programs in rural settings.

Among the study’s key findings:

· In addition to their drug habits, participants were compromised by unstable housing, illegal incomes and frequent encounters with the criminal justice system—a combination putting them at a “crucially elevated risk” of health problems· Participants displayed a “high prevalence” of concurrent physical and mental health problems· Crack use tended to occur in conjunction with the use of a variety of other legal and illegal “psychoactive substances,” including alcohol, cocaine and opioids· Participants exhibited HIV and HCV rates similar to rates observed in primary injection-drug users; alarmingly, many users with HCV did not know they were infected· Subjects assembled their crack-use paraphernalia mostly from high-risk materials such as scrap metal, metal piping or broken glass, leading to oral burns, cuts and other mouth injuries conducive to infectious disease transmission· Most participants “saw any attempt to quit crack as a futile effort” given the current acute lack of viable treatment options

Citing the “high prevalence of crack use” across Canada, the study calls for “the comprehensive improvement of preventive and treatment intervention services,” specifically:

· Improved resources and training for health workers to address the complex and intertwined health challenges faced by crack users· Improved accessibility to infectious-disease testing in the study locations· “Crack kit” distribution programs that include information on prevention and health care· Safer inhalation facilities for crack users, akin to those found in Europe· More research into and expansion of treatment options

Says Fischer: “In many B.C. communities, crack use is the number one street drug problem, yet we give it much lower attention than other forms of drug use.

“We need better and more targeted prevention and treatment for crack use in order to reduce its enormous negative public health impact.”

The study was supported by funds from the B.C. Ministry of Healthy Living and Sports, the Vancouver Island Health Authority and the Canadian Institutes of Health Research.

Tuesday, July 6, 2010

What would you do if you saw your child talking back to voices and things that weren't there? If your spouse started becoming paranoid and telling you they were being spied on and people were following them? If your aging parent starts hoarding things and telling you stories about people knocking them down and hurting them? What if your loved one becomes a person you do not know right before your eyes?

These are all signs and symptoms of mental illness. And unchecked, they will get much, much worse, to the pain of everyone. It is a tragedy that every day in this province people, children, youth and adults, who have a legitimate mental health care needs often do not get the help and support they need before things go from bad to worse.

Mental health and addiction services in BC are being decimated, the old death by a thousands cuts method of "austerity," to the neoCon crowd. The problem is that it's all adding up to one HUGE MISTAKE. For everyone.

People with mental illness need multi-disciplinary and timely care and help.

They need assessment. They need treatment. People sometimes need medications. And many need case management.

People also often need counselling to help them deal with the often painful realities of living with a serious mental illness - the stigma, the marginalization, the difficulty accessing affordable housing and adequate incomes if they are on disability.

Sometimes they need hospitalization to stabilize and to stop themselves from harming themselves, or others. Not everyone. But some.

They need affordable housing, a continuum - from supportive to independent.

Family members need help and support too. Information, knowledge and to be considered part of the care team of the individual.

People with mental illness need and deserve dignity, compassion, human rights and social justice.

I have heard the stories of those who tried to get their loved ones help to prevent tragedy from occurring. Watching a train wreck in action where they are shouting but no-one is listening, or helping as the loved one yells for someone to help and care. Nobody should have to go through that, the individual who needs care or the family and friends. Mental health care is a human right.

Alan Campbell couldn't believe the kind of care and support his wife received after being diagnosed with breast cancer five years ago.

The speedy treatment. The kind words. The follow-up calls and offers of support. It was an amazing experience, says Campbell -- and all the more striking when compared to the level of care his own clients typically see.

Campbell has spent the last 34 years working in B.C.'s mental-health system, most recently as director of mental health and addictions for the Vancouver Island Health Authority.

I'm sure he would have liked to have been finishing off his career this week reflecting on the tremendous gains made around mental-health care in his time. That's certainly been the case for breast cancer and for many other major health concerns that we've tackled with fervour in the last three decades.

Alas, Campbell retired Wednesday from a field that is very nearly as underfunded, misunderstood and stigmatized as it was when he got into it in 1976. Had his wife been diagnosed with bipolar disorder or schizophrenia instead of breast cancer, her family's journey through a fractured and overwhelmed mental-health system would have been very, very different from the experience they had at the tender hands of the B.C. Cancer Agency.

Why is that? Why does one disease get the resources it needs to do things exactly right, and another have to beg for leftovers at the back of the line?

Mental illness affects one in five people on Vancouver Island, 20 per cent, yet its share of health-care spending is a mere eight per cent.

In B.C. overall, spending on mental health and addictions accounts for just six per cent of the health budget.

"We haven't figured out how to get behind mental health as a country," says Campbell. "It's not just a problem here. In other regions, other provinces, the same dynamic exists. When we compare ourselves to other countries, we don't look good."

Campbell's final months at VIHA can't have been fun, what with the outrage building in the local psychiatric community over the loss of even more mental-health services.

In recent weeks, a doctor with the Schizophrenia Affective Disorders Clinic, Dr. Adam Gunn, resigned over the cuts. Dr. Anthony Barale has closed his outpatient service at Victoria General Hospital for people with brain injuries, saying he can't support a system that's failing patients and their families.

Dr. Andre Masters noted those resignations in a letter to the editor last month, and says more are likely coming. VIHA's Department of Psychiatry passed a motion last fall condemning everything about the way budget deliberations were handled at VIHA.

Yes, there's an urgent need for more spending on mental-health services, says Campbell. But when his department takes that message forward, the answer is usually "no," he adds.

"For every one of the five years I've been doing this job, we've put forward strong, well-reasoned cases for more funding," he says of his department. "The only time we were successful was in getting money for the Mayor's Task Force on Homelessness. My understanding is that our requests are given real consideration, but they just don't fare well in the end."

Nor does it go well when VIHA starts moving money around on the Island, taking funding away from places like Victoria and Nanaimo in order to provide more services in places like Port Hardy and Duncan. Mental-health services may be insufficient in Greater Victoria, but they're downright dismal elsewhere on the Island, says Campbell.

The economy will eventually improve, of course, and brighter days will dawn for many of the health, education and social services under the knife right now.

But that won't get to the fundamental problem plaguing mental-health services, which is that they are buried at the bottom of the priority list for health spending even in the best of economic times.

Once upon a time, cancer treatment was poorly funded and misunderstood as well. But brilliant minds as far back as 1938 saw a way to address that problem, and the foundations of what would eventually become the B.C. Cancer Agency were put in place.

Its mandate and practices are everything that health care should be: Consistent and thorough; well-resourced; research-based; thoughtful. It's a made-in-B.C. blueprint for doing things differently around mental health. So is the province's new

10-year mental-health plan, if it's able to become something more than just words on paper.

What can you do in the meantime?

Write B.C. Health Minister Kevin Falcon (kevin.falcon.mla@leg.bc.ca)

Health Canada Minister Leona Aglukkaq (aglukkaq.l@parl.gc.ca)

Tell them that mental-health care matters. Governments won't change unless we make them.